Neutrophilic eccrine hidradenitis unassociated with chemotherapy in a patient with acute myelogenous leukemia

Abstract

An 18-year-old female patient with acute myelogenous leukemia (AML) M2 was treated between March and June 1998 with idarubicin, cytarabine, busulfan and cyclophosphamide. In June 1998, an autologous hematopoietic peripheral blood stem cell transplant was performed. The patient was asymptomatic without treatment until January 1999, when a relapse of AML was observed. In March 1999, when the patient was waiting for another allogenic hematopoietic transplantation, she presented to the Department of Dermatology, Clínica Universitaria Puerta de Hierro, Madrid, with an acute onset a few days previously of macular, slightly elevated, irregular patches with ill-defined borders, confined to the anterior aspect of the trunk in a bilateral distribution, especially on both breasts (Fig. 1). The eruption was asymptomatic. The patient had not received any treatment of any kind in the preceding weeks before the appearance of the cutaneous lesions. She had received a blood transfusion 3 weeks previously. The patient also had a low-grade fever (37.8 °C). Figure 1Open in figure viewerPowerPoint Irregular, ill-defined erythematous plaque on the right breast Laboratory investigations showed pancytopenia and a slight elevation of hepatic enzymes. The rest of the parameters were within the normal range. Blood cultures were negative. Histologic examination of a biopsy specimen taken from a cutaneous lesion showed a normal epidermis, a dermis with a sparse interstitial neutrophilic infiltrate, and a dense inflammatory infiltrate composed almost exclusively of neutrophils in and around the secretory portion of the eccrine glands (Fig. 2). The presence of necrotic epithelial cells was remarkable. Figure 2Open in figure viewerPowerPoint Dense neutrophilic infiltrate affecting the whole secretory portion of an eccrine gland Immunohistochemical techniques and special staining for bacteria or fungi did not provide any additional data. The cutaneous eruption disappeared spontaneously in 2 weeks. An allogenic hematopoietic transplantation was performed. The patient died on day + 27 due to hepatic and pulmonary complications.